Provider Demographics
NPI:1598704017
Name:SMITH, JOSHUA J (PT)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:J
Last Name:SMITH
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:429 W MAIN ST
Mailing Address - Street 2:STE B
Mailing Address - City:LEXINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61753-1258
Mailing Address - Country:US
Mailing Address - Phone:312-640-0329
Mailing Address - Fax:
Practice Address - Street 1:1704 EASTLAND DR
Practice Address - Street 2:UNIT 15
Practice Address - City:BLOOMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61704-3523
Practice Address - Country:US
Practice Address - Phone:309-664-7766
Practice Address - Fax:309-664-6767
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070014650225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist